Healthcare Provider Details

I. General information

NPI: 1609714211
Provider Name (Legal Business Name): SERENITY BRIDGE TELEPSYCHIATRY & WEIGHT MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MEADOW OVERLOOK DR
COVINGTON GA
30016
US

IV. Provider business mailing address

2274 SALEM RD SUITE 106, #1259
CONYERS GA
30013-2295
US

V. Phone/Fax

Practice location:
  • Phone: 470-236-1785
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STELLA THOMAS
Title or Position: NURSE PRACTITIONER
Credential: NP
Phone: 470-236-1785